Ear infections are one of the most common illnesses of early childhood. The medical name for ear infection is otitis media, meaning inflammation of the middle ear.

How do ear infections occur?

As you can see in the diagram of the middle ear, there is a passageway called the eustachian tube, which connects the middle ear with the back of the throat and nose (the nasopharynx). The middle ear is usually filled with air, and the eustachian tube serves to equalize the pressure. It's your eustachian tube that causes the "popping" sensation when you go up in an airplane or climb a mountain.

When a child gets an infection of the nose or throat (upper respiratory infection), sometimes the lining of the eustachian tube, or its outlet, can become blocked. An airlock develops in the middle ear. The child may tug at his ears as they have a sensation of fullness. As the pressure builds, the child experiences pain, in much the same way people can feel twinging or sudden sharp pains when flying on an airplane.

Why antibiotics are often not needed

Many ear infections are due to respiratory viruses. There is clear fluid within the middle ear and the pain is due to pressure. The fluid will resolve spontaneously and the viral infection is cleared by the immune system. Antibiotics will have no effect and can cause potential problems like diarrhea and allergic reactions. When antibiotics are widely used, strains of "resistant" bacteria, which are immune to the antibiotic can evolve, making it more difficult for antibiotics to work when they are really needed.

Why antibiotics are sometimes needed

Bacteria in the back of the throat can become trapped in the eustachian tube and extend into the middle ear. The germs set off an inflammatory response. The child develops a fever and usually experiences more pain, especially at night as the child lies on the affected side. When the doctor looks at the child's ear drum, there is more inflammation and sometimes a bulging abscess. This type of ear infection is treated with antibiotics.

After the child starts antibiotics, it will still take a few days for the pressure and inflammation to subside. If symptoms persist more than two days, the child should be rechecked. Sometimes, the antibiotic has to be changed because the middle ear fluid is harboring bacteria that are "resistant" to Amoxacillin, the medicine usually used as first line therapy.

Bacterial ear infections are potentially serious. They can cause hearing loss by damaging the delicate middle ear structures. Also, because of the middle ear's proximity to the brain and cerebral blood vessels, a severe, untreated ear infection could lead to meningitis (infection of the lining of the brain). In the days before antibiotics, children could develop mastoiditis, an infection of the mastoid bone which is right behind the ear.

Alleviating pain

To help alleviate pain, ibuprofen (Motrin or Advil) or acetaminophen (Tylenol) can be used. Ibuprofen has more of an impact, so try to give it before the child goes to sleep. You can repeat it six hours later. You can alternate ibuprofen and acetaminophen every 3-4 hours for severe pain. An antihistamine like Benadryl can help a child fall asleep.

Some old fashioned tricks for ear pain

Place a few drops of icy cold water in the affected ear.

Another trick, place a small heating pad on the mother's or father's chest, and letting the child sleep upright on your chest with the affected ear lying on the pad.

To make a small heating pad

Put a cup of uncooked rice in a thick sock, sprinkle some salt in with the rice to help 'hold the heat', tie the top, and place the sock in a microwave oven for about 60 seconds. It makes a nice heating pad. Placing it against the parent's chest assures that it's not too hot.